NURS 317 Unit 2 Chapter 57 Pharm Point Questions

Question 1

The nurse administers sucralfate to a client with oral and esophageal ulcers caused by cancer treatment. What is the priority nursing care for this client?

A) Assessing the client bowel pattern

B) Monitoring the integrity of the client’s mucous membranes

C) Monitoring the client’s electrolyte levels and red cell indices

D) Cardiac monitoring

Answer 1

B) Monitoring the integrity of the client’s mucous membranes

Rationale:A care priority is monitoring for therapeutic effect. Bowel patterns should be monitored, but therapeutic effect is the main focus of care. Cardiac and electrolyte disturbances are unlikely.

Question 2

The nurse, caring for a client taking sodium bicarbonate, suspects that the client is in a state of metabolic alkalosis when assessing what manifestations? Select all that apply.

A) Tetany

B) Elevated serum calcium levels

C) Confusion

D) Constipation

E) Muscle twitching

Answer 2

A) Tetany
C) Confusion
E) Muscle twitching

Rationale:Confusion, muscle twitching, and tetany are manifestations of metabolic alkalosis. Constipation and elevated serum calcium levels are not considered manifestations of metabolic alkalosis.

Question 3

Which statement by a client receiving pancrelipase indicates that the client has understood the nurse’s client teaching?

A) “I’ll take it first thing in the morning after getting up.”

B) “I should take the drug with meals and snacks.”

C) “I should take the drug 1 hour before I eat.”

D) “I must take the drug at bedtime for best results.”

Answer 3

B) “I should take the drug with meals and snacks.”

Rationale:Pancrelipase is taken with meals and snacks so the enzyme is available to digest the food. Taking it before bedtime, in the morning, or before eating would not put the enzyme in contact with the food when the client eats.

Question 4

The client receiving omeprazole should swallow the tablet whole with a large glass of water.

A) FALSE

B) TRUE

Answer 4

B) TRUE

Rationale:Omeprazole should be swallowed whole to ensure the therapeutic effectiveness of the drug. A large glass of water is encouraged to promote absorption.

Question 5

The use of calcium carbonate is associated with the development of acid rebound.

A) FALSE

B) TRUE

Answer 5

B) TRUE

Rationale:Calcium carbonate is actually precipitated chalk and is available in tablet and powder forms. The main drawbacks to this agent are constipation and acid rebound.

Question 6

What H2 receptor antagonists would be safest for the nurse to administer to a client with hepatic dysfunction?

A) Nizatidine

B) Ranitidine

C) Famotidine

D) Cimetidine

Answer 6

A) Nizatidine

Rationale:Only nizatidine does not undergo first-pass metabolism in the liver like the other histamine-2 receptor antagonists. Famotidine, ranitidine, and cimetidine undergo first-pass metabolism in the liver.

Question 7

A client is prescribed esomeprazole. The nurse can administer this drug by which routes? Select all that apply.

A) Intravenous

B) Topically

C) Subcutaneous

D) Oral

E) Intramuscular

Answer 7

A) Intravenous
D) Oral

Rationale:Esomeprazole is available for use in delayed-release oral form and as an IV preparation.

Question 8

A client is prescribed misoprostol. The nurse would expect to administer this drug by which route?

A) Intravenous

B) Transdermal

C) Oral

D) Subcutaneous

Answer 8

C) Oral

Rationale:Misoprostol is administered orally.

Question 9

Saliva substitute is absorbed systemically.

A) TRUE

B) FALSE

Answer 9

B) FALSE

Rationale:Saliva substitute is not generally absorbed systemically.

Question 10

A client reports symptoms of gastroesophageal reflux and requests a proton pump inhibitor (PPI). What aspect of this client’s current health status would contraindicate the safe use of a PPI?

A) The client has a family history of prostate cancer.

B) The client was treated for pneumonia with levofloxacin 2 months ago.

C) The client has ischemic heart disease and takes clopidogrel.

D) The client has a penile implant.

Answer 10

C) The client has ischemic heart disease and takes clopidogrel.

Rationale:There is an increased risk of cardiovascular events if proton pump inhibitors are combined with clopidogrel; this combination should always be avoided. None of the other aspects of the client’s health history are problematic.

Question 11

An adult client with a history of peptic ulcer disease reports that she has begun producing small amounts of milk, despite not being pregnant or breast-feeding. What assessment should the nurse perform?

A) Assess the client for recent episodes of gastroesophageal reflux.

B) Determine whether the client has been taking cimetidine.

C) Assess the client’s use of over-the-counter antacids.

D) Determine whether the client ever takes sodium bicarbonate.

Answer 11

B) Determine whether the client has been taking cimetidine.

Rationale:Cimetidine has been associated with antiandrogenic effects such as galactorrhea. Sodium bicarbonate and other antacids do not have this effect. Reflux would likely be unrelated, either as a cause or an effect.

Question 12

What drug would be appropriate for the nurse to administer to a child if a proton pump inhibitor was to be given?

A) Rabeprazole

B) Esomeprazole

C) Lansoprazole

D) Omeprazole

Answer 12

C) Lansoprazole

Rationale:Lansoprazole is the only proton pump inhibitor approved for use in children and would be the drug of choice.

Question 13

What H2 antagonist would the nurse identify as most potent?

A) Famotidine

B) Nizatidine

C) Ranitidine

D) Cimetidine

Answer 13

A) Famotidine

Rationale:Famotidine is much more potent than either cimetidine or ranitidine. Nizatidine is similar in effectiveness to ranitidine.

Question 14

The nurse is caring for a client presenting with diarrhea who reports taking frequent antacids. What type of antacid does the nurse suspect the client has been taking?

A) Aluminum salts

B) Calcium carbonate

C) Maalox

D) Magnesium salts

Answer 14

D) Magnesium salts

Rationale:Magnesium salts are very effective in buffering acid in the stomach but have been known to cause diarrhea. Calcium carbonate causes constipation and acid rebound. Aluminum salts have been related to severe constipation. Maalox is a combination of calcium and aluminum salts that buffers acid and produces neither constipation nor diarrhea.

Question 15

What classification of drug would a nurse expect to administer if the goal of therapy is to block the release of hydrochloric acid in the stomach?

A) Antacid

B) Proton pump inhibitor

C) Histamine-2 receptor antagonist

D) Prostaglandin

Answer 15

C) Histamine-2 receptor antagonist

Rationale:Histamine-2 (H2) antagonists block the release of hydrochloric acid in response to gastrin. Proton pump inhibitors suppress the secretion of hydrochloric acid into the lumen of the stomach. Antacids interact with acids at the chemical level to neutralize them. Prostaglandins inhibit the secretion of gastrin and increase the secretion of the mucous lining of the stomach, providing a buffer.

Question 16

For what purpose will the nurse administer an H2 receptor antagonist to a client with significant burn trauma?

A) The drug decreases the acid being regurgitated into the esophagus.

B) The drug provides protection of the stomach lining to prevent stress ulcers.

C) The drug blocks overproduction of hydrochloric acid in the esophagus.

D) The drug stops acids from passing through the pyloric sphincter into the duodenum.

Answer 16

B) The drug provides protection of the stomach lining to prevent stress ulcers.

Rationale:Histamine-2 receptor antagonists are used for stress ulcer prophylaxis because the drugs block the production of acid, thereby protecting the stomach lining, which is at risk because of decreased mucus production. Decreasing the acid being regurgitated into the esophagus explains the reason for use of the drug to treat erosive gastroesophageal reflux. Acidic stomach contents cannot be blocked from passage into the duodenum. Acid is not produced in the esophagus.

Question 17

The nurse has been administering repeated doses of intravenous ranitidine to client. When monitoring for adverse effects, what assessment should the nurse prioritize?

A)_ Heart rate and rhythm

B) Activity tolerance

C) Lung auscultation

D) Monitoring for seizure activity

Answer 17

A)_ Heart rate and rhythm

Rationale:H2 antagonists can cause arrhythmias, especially when given intravenously. Respiratory effects and seizure activity are unlikely. Cardiac effects pose a greater safety risk than decreased activity.

Question 18

A client with an active gastrointestinal bleed has been determined to need an intravenous infusion of a proton pump inhibitor. What medication should the nurse prepare to administer?

A) Dexlansoprazole

B) Omeprazole

C) Pantoprazole

D) Rabeprazole

Answer 18

C) Pantoprazole

Rationale:Esomeprazole, lansoprazole, and pantoprazole are available in delayed-release oral forms and as IV preparations. Rabeprazole, dexlansoprazole, and omeprazole are available only in delayed-release oral forms.

Question 19

The nurse is preparing a teaching plan for a client who is receiving sucralfate. What teaching points will the nurse include? Select all that apply.

A) Taking the drug on an empty stomach

B) Using an antidiarrheal agent

C) Ensuring safety precautions

D) Eating a high-fiber diet

E) Limiting fluid intake

F) Encouraging frequent mouth care

Answer 19

A) Taking the drug on an empty stomach
C) Ensuring safety precautions
D) Eating a high-fiber diet
F) Encouraging frequent mouth care

Rationale:Constipation is the most common adverse effect. A high-fiber diet is needed to prevent constipation. Dizziness and vertigo can occur with this drug; safety precautions would be important. The drug should be taken on an empty stomach 1 hour before or 2 hours after meals to ensure therapeutic effectiveness. Frequent mouth care is important in combating dry mouth, which is associated with this drug. Constipation is the most common adverse effect. Increased fluid intake is needed to promote bowel elimination. It also helps to combat dry mouth. Diarrhea can occur, but it is not a common adverse effect and would most likely require dietary adjustments, not drug therapy.

Question 20

When teaching a client how to prevent acid rebound, the nurse should suggest what action?

A) Follow the administration schedule of proton pump inhibitors closely.

B) Sit upright for at least 30 minutes after eating or drinking.

C) Avoid using antacids any more than necessary.

D) Eat an occasional high-acid meal to inactivate parietal cells.

Answer 20

C) Avoid using antacids any more than necessary.

Rationale:Acid rebound occurs when the stomach produces more gastrin and more acid in response to lowered acid levels in the stomach, which commonly occurs with the use of antacids. Lessening antacid use is likely to reduce an individual’s risk for acid rebound. Eating acidic foods has no beneficial effect. Sitting upright after eating and following administration schedules closely are desirable actions, but neither affects the risk of acid rebound.

Question 21

A client is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic?

A) Ranitidine

B) Cimetidine

C) Omeprazole

D) Sucralfate

Answer 21

C) Omeprazole

Rationale:Omeprazole is a proton pump inhibitor, which is used as part of combination therapy to treat H. pylori infections. Cimetidine and ranitidine are H2 receptor antagonists used to treat duodenal and benign gastric ulcers.

Question 22

Pancrelipase would most likely be used to treat a client with cystic fibrosis.

A) FALSE

B) TRUE

Answer 22

B) TRUE

Rationale:Pancrelipase aids digestion and absorption of fats, proteins, and carbohydrates in conditions that result in a lack of this enzyme. It is used as replacement therapy in clients with cystic fibrosis, chronic ductal obstruction, pancreatic insufficiency, steatorrhea, or malabsorption syndrome and after pancreatectomy or gastrectomy.

Question 23

For what potential adverse effects would the nurse assess in the client receiving misoprostol? Select all that apply.

A) Dizziness

B) Dyspepsia

C) Excessive vaginal bleeding

D) Vertigo

E) Flatulence

Answer 23

B) Dyspepsia
C) Excessive vaginal bleeding
E) Flatulence

Rationale:Flatulence is a possible adverse effect. Excessive vaginal bleeding is a possible adverse effect of misoprostol. Dyspepsia is a possible adverse effect of misoprostol. Dizziness and vertigo are not associated with misoprostol.

Question 24

If a client is receiving sucralfate and omeprazole, the doses can be taken together.

A) TRUE

B) FALSE

Answer 24

B) FALSE

Rationale:Sucralfate is not absorbed well in the presence of proton pump inhibitors, and doses should be spaced at least 30 minutes apart if both drugs are prescribed.

Question 25

The nurse administers cimetidine to the client and anticipates the drug will have what duration of action when given IV?

A) 12 to 16 hours

B) 1 to 2 hours

C) 4 to 5 hours

D) 30 to 60 minutes

Answer 25

C) 4 to 5 hours

Rationale:Whether cimetidine is given IV, IM, or PO, the duration of action is expected to be 4 to 5 hours, although this may be prolonged in clients with renal dysfunction.